前立腺癌に対する小線源治療後の下部尿路症状の解析

Abstract

A total of 320 localized prostate cancer patients including 272 at low-risk and 48 at intermediate-risk were treated with permanent iodine-125 seed implants. Changes of lower urinary tract symptoms after the treatment were analyzed for one consecutive year using international prostate symptom score, quality of life (QOL) score and uroflowmetry. These patients did not have prostate hypertrophy or were not treated with any α1 blocker before the seed implant. Tamsulosin (0.2 mg/day) was prophylactically administered to all the patients for six months beginning the day after the seed implant. Both voiding and storage symptoms developed even in patients without any urinary symptoms before seed implant and worsened during the consecutive three months ; and, QOL also worsened after seed implant. Lower urinary tract symptoms continued to be significantly severe for six months compared with that before the seed implant, then improved gradually to almost the initial level after one year. It seems to take longer for storage symptoms to diminish to the initial level compared with voiding symptoms. Neoadjuvant hormone therapy improved neither voiding nor storage symptoms in patients without prostate hypertrophy less than 40 ml in volume. In conclusion, a more effective α1 blocker or other potent prophylactic drug therapy should be used on the patients after seed implant because the disadvantage of seed implant is probably only urinary disturbance.